Study: Many Elders Given Wrong Drugs

November 28, 2004

Doctors in the United States are prescribing inappropriate and potentially harmful drugs to more than one in five older patients, according to a new study examining data from more than three- quarters of a million elders.

Lesley Curds of Duke University Medical Center in Durham, N.C., and colleagues analyzed 1999 claims data from a national pharmaceutical benefit management company. The study, which appeared in Archives of internal Medicine (Aug. 9/23, 2004), showed that 21% of elders-more than 162,000 people in the survey data-who filled at least one prescription did so for a drug deemed to be potentially inappropriate according to the Beers revised list of prescription drugs. Created by a panel of physicians and pharmacologists headed by respected medical researcher Mark H. Beers, this standard list includes pharmaceutical s widely known to cause side effects in elders. More than 15% of the patients filled prescriptions for two drugs on the list, and 4% filled prescriptions for three or more listed drugs. The troublesome compounds that were most commonly prescribed were psychotropic or neuromuscular drugs.

WORRISOME

The study confirmed other research conducted during the last decade, which the authors called “noteworthy-and worrisome.” The research team added, “Our analysis likely underestimates the occurrence of potentially inappropriate prescribing in the elderly population.”

Curtis told the British Medical Journal, “Concerns over the cost of potentially inappropriate medications are warranted, but the potential costs of adverse events related to these medications are of even more concern. This is an area that clearly has not been adequately investigated.”

The study called for new efforts to prompt pharmaceutical researchers to enroll elders in clinical trials to increase the evidence base on medications for older patients. Furthermore, the authors suggest using existing criteria to identify elderly patients who are at high risk for suboptimal prescribing and to prioritize further studies. Also, they recommend encouraging “the use of systems and technologies that support optimal prescribing behavior- such as drug-utilization review, computerized physician order entry with decision support, and palmtop reference guides.” Noting that such systems “are only as good as the information on which they rely,” Curtis and colleagues emphasize that to be complete, clinical and laboratory data must be combined with medical and pharmaceutical claims data.

In an editorial accompanying the study, Knight Steele of Hackensack University Medical Center, N.J., stated that the article by Curtis and colleagues “bespeaks a significant failure in the American healthcare system.” He stressed that although the drugs included on a list such as the one compiled by Beers and fellow health professionals may vary with different panel members, “if even half that number of elderly subjects are taking potentially inappropriate medications, one in 10 of all older persons is receiving a drug that is potentially not appropriate.”